Reports to the Executive Director, Corporate Business Services with the responsibility for revenue cycle management and has overall responsibility for the management, direction and control of the activities of the Professional Billing Operation. Ensures that the billing and follow-up processes are effective and that accounts receivable objectives are on target. Ensures positive interaction with third party representatives and managed care companies to facilitate operations and promote good customer relations in the work environment. Provides direction during the expansion of the operation when new physician offices or services are acquired. Facilitates communication and the development of new work flows that are consistent with billing and regulatory requirements. Ensures effective use of Epic system to support all areas of revenue cycle as well as financial reporting. Acts as a liaison between contracting department for interpreting physician contracts, identifying required changes to system and claims adjudication Oversees the denial review process to avoid unnecessary denials and maximize reimbursement. Recommends and provides justification of the write-off of delinquent accounts and the turnover to agencies and attorneys. Analyzes and makes recommendations to enhance all related systems in order to achieve desired results. Develops staff to optimize their personal growth and contributions to the organization. Demonstrates and communicates sensitivity to the needs and concerns of all customers, employees and co-workers in the performance of work activities.
- 1. Directs and coordinates all aspects of revenue cycle management of the professional billing operation. Organizes and coordinates resources, human and fiscal, to achieve goals by developing, assessing, implementing and evaluating effective and efficient systems that lead to increasingly positive outcomes and opportunities for increased cash flow.
- 2. Ensure the financial well-being of the organization, and cash flow through healthy accounts receivables management and the development of key relationships. Regularly interacts with representatives from these organizations in order to facilitate the collection of the receivable.
- 3. Represents interests of revenue cycle management by working collaboratively with the Information Systems department to search out new system solutions. Implements operational changes necessitated by changing systems and regulations.
- 4. Develops accounts receivable targets, in accordance with corporate goals and projects cash flow. Provides explanation for any variance between target receivable goals and actual results to senior leadership
- 5. Analyzes governmental and non-governmental rejection trends and communicates findings. Address situations throughout the organization which hinder the reduction of accounts receivable.
- 6. Provide oversight for staff responsible for charge capture, coding/charge entry, insurance follow up, reimbursement analysis, or other financial functions
- 7. Responsible for setting departmental and organizational productivity standards; and strategic planning to optimize collections.
- 8. Represents the Corporate Business Services department and works closely with physician office leadership and senior leadership throughout the entities to develop effective organizational strategies.
- 9. Review and recommend changes to physician office charge capture process to facilitate accurate and comprehensive billing in compliance with all regulations. Provide direction for staff responsible for charge capture, coding, charge entry, insurance follow up, reimbursement analysis, denial management or other financial functions.
- 10. Direct the development, recommendation and implementation of operation and financial budgets.
- 11. Works on special projects requested by Executive Director. Participates in meetings, projects and surveys relative to the effective management and function of Corporate Business Services.
- 12. Prepares and distributes effective management reports.
Bachelor's Degree in Accounting, Business Administration or related field. Master's in Business Administration or Public Health required.
Ten (10) plus years progressive experience in a senior leadership role at large healthcare revenue cycle management operation, including significant financial reporting experience and demonstrated accomplishments in a physician billing environment.
Proven abilities in leadership, initiative and sound judgment required. Strong communication and interpersonal skills and the ability to effectively communicate financial issues to all levels of management. Knowledge of physician revenue cycle systems, governmental and regulatory billing and reimbursements essential. Ability to motivate and direct activities of a large and diverse staff. Ability to identify and implement recommendations and work with all levels of management throughout physician offices and the hospitals.
Yale New Haven Health System, through its Yale New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost-effective, advanced patient care characterized by safety and clinical and service quality.
Yale New Haven Health System, in affiliation with Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care.
In all of its work, YNHHS is committed to the communities it has the privilege of serving.